Long-term satisfaction after gender-affirming laparoscopic sigmoid vaginoplasty in transgender women: a comparison with penile inversion vaginoplasty.

Authors

Marleen S Vallinga, Julia E Hollander, Tim C van de Grift, Nanne K H de Boer, Jurriaan B Tuynman, Mark-Bram Bouman, Margriet G Mullender, Wouter B van der Sluis

Published in

The journal of sexual medicine. Volume 23. Issue 7. Jun 05, 2026.

Abstract

Gender-affirming laparoscopic sigmoid vaginoplasty (SV) is an established alternative to penile-inversion vaginoplasty (PIV) when there is insufficient penoscrotal tissue available. However, long-term satisfaction with the sigmoid vagina remains unclear.
To assess the long-term patient-reported outcomes (PROs) after SV in transgender women, and compare these outcomes with a reference group of transgender women who underwent PIV.
A single-center, cross-sectional survey study was conducted, including transgender women who underwent primary SV at least 5 years prior and matched transgender women who underwent PIV. Matching was based on age (±5 years) and operation date (±2 years). Outcomes were compared between groups. Retrieved clinical data comprised medical history, perioperative characteristics, complications, and reoperations.
Primary outcomes were satisfaction with vagina (GENDER-Q Vagina and Dilation scales) and genital self-image (Female Genital Self-Image Scale). Secondary outcomes were satisfaction with surgery, current complaints (self-constructed questionnaire), sexual well-being (GENDER-Q Sexual well-being scale), and satisfaction with life (Satisfaction with Life Scale and the Cantril Ladder).
Of 58 eligible SV candidates, 35 participated and were matched to 35 PIV participants. Follow-up was 10 years (IQR 7-12). The frequency and severity of intra- and postoperative complications did not differ significantly between groups. Reported satisfaction with the vagina was moderate in both groups (SV 44.4 ± 11.1; PIV 47.3 ± 18.2, P = .43), as was genital self-image (SV 18.8 ± 3.3; PIV 18.9 ± 5.4, P = .89) and sexual well-being (SV 52.2 ± 20.2; PIV 57.2 ± 18.4, P = .33). Sigmoid vaginoplasty and PIV groups rated their satisfaction with the surgical result 7.1 ± 1.7 vs 6.9 ± 1.9 out of 10 (P = .62). Satisfaction with genital appearance and longer time since surgery were associated with higher satisfaction with the vagina, whereas more severe postoperative complications predicted lower satisfaction. In both groups, 69% of individuals reported genital complaints. Stated reasons for dissatisfaction were related to genital esthetics, voiding complaints, genital pain, and an inability to use the vagina as desired.
The present findings support SV as a viable alternative to PIV when indicated and inform preoperative counseling on long-term clinical outcomes and PROs.
Strengths of the study include the comparative design with a matched reference group, long-term follow-up, and the use of validated questionnaires. Limitations include a single-center setup, cross-sectional design, and potential response and selection biases.
Across all clinical outcomes and PROs, no significant differences were found between SV participants and PIV participants. Overall satisfaction was moderate, and genital complaints were prevalent in both groups.

PMID:
42296272
Bibliographic data and abstract were imported from PubMed on 16 Jun 2026.

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